Ebook: Informatics Empowers Healthcare Transformation

The current volume presents the accepted papers of the ICIMTH (International Conference on Informatics, Management, and Technology in Healthcare). The Organising Committee and the Scientific Programme Committee would like to present to the academic community the scientific outcomes of the ICIMTH 2017 Conference, held from 7 to 9 July 2017 in Athens, Greece.

The ICIMTH 2017 Conference is the 15th Annual Conference in this series of scientific events, gathering scientists from all continents as well as from the hosting country in the field of Biomedical and Health Informatics.

The Conference focuses on the empowerment of the Healthcare by the Biomedical Informatics applications in the whole spectrum from Clinical Informatics, Health Informatics to Public Health Informatics as applied in the Healthcare domain. Considering that management and organisational issues play an important role in the implementation phase of Biomedical Informatics applications, topics related to the above themes are also included as an integral part to the overall theme of the conference. We are treating the field of Biomedical Informatics in a very broad framework examining the research and applications outcomes of Informatics from cell to populations, including a number of Technologies such as Imaging, Sensors, and Biomedical Equipment and Management and Organisational subjects, such as legal and social issues and setting research priorities in Health Informatics. In essence, Informatics empowers the Healthcare Transformation.

This volume incorporates only the full papers accepted for oral presentation. It should be noted that the proceedings are published in this series of the conference as an e-book with e-access for ease of use and browsing without losing any of the advantages of indexing and citation in the biggest scientific literature databases, such as Medline and Scopus that the series of Studies in Health Technology and Informatics (SHTI) of IOS Press provides.

At the time of the deadline we had 97 submissions, from which after reviewing we have accepted 65 as full papers to be included in the volume proceedings.

The Editors would like to thank the Members of the Scientific Programme Committee, the Organising Committee, and all Reviewers, who have done a thorough and objective refereeing of the scientific work to produce a high quality publishing achievement and a successful scientific event.

Athens, 9.06.2017

The Editors,

John Mantas, Arie Hasman, Parisis Gallos, and Mowafa S. Househ

In the era of digitization some new procedures play an increasing role for diagnosis as well as for therapy: informatics diagnostics and informatics therapeutics. Challenges for such procedures are described. It is discussed, when research on such diagnostics and therapeutics can be regarded as good research. Examples are mentioned for informatics diagnostics and informatics therapeutics, which are based on health-enabling technologies.

Health Informatics is an ever evolving, changing and dynamic field that has become the disruptive innovation shaping the future of healthcare. Health informaticians face a number of challenges in the workplace such as gaining acceptance and recognition from other healthcare providers and overcoming the resistance of healthcare providers from using technology in clinical practice. Being a health informatician is not for the faint hearted, especially as resistance to the role of health informaticians continues from both healthcare providers and hospital administrators. As health informaticians move from behind the scenes to the front line of todays modern healthcare organization, more leadership training is needed for health informaticians in dealing with the changing demands of the healthcare industry and rapid changes in technology innovations. Waking up everyday with the same passion and purpose to lead others and drive change within healthcare organizations requires the health informatician to find the internal passion that will be transformed into external actions guiding the health informatician in how they lead, communicate, work, think, and treat others within the workplace. The purpose of this paper is to help health informaticiains tap into and develop their passion for the field of health informatics so that they can lead with purpose to improve how healthcare is practiced and delivered, making a lasting change in the overall healthcare system.

Much research has been done in the last few decades in clinical research, medicine, life sciences, etc. leading to an exponential increase in the generation of data. Managing this vast information not only requires integration of the data, but also a means to analyze, relate, and retrieve it. Ontology, in the field of medicine, describes the concepts of medical terminologies and the relation between them, thus, enabling the sharing of medical knowledge. Ontology-based analyses are associated with a risk that errors in modeling may deteriorate the results' quality. Identifying flawed practices or anomalies in ontologies is a crucial issue to be addressed by researchers. In this paper, we review the negative sides of ontology in the field of medicine. Our study results show that ontologies are perceived as a mere tool to represent medical knowledge, thus relying more on the computer science-based understanding of medical terms. While this approach may be sufficient for data entry systems, in which the users merely need to browse the hierarchy and select relevant terms, it may not suffice the real-world scenario of dealing with complex patient records, which are not only grammatically complex, but also are sometimes documented in many native languages. In conclusion, more research is required in identifying poor practices and anomalies in the development of ontologies by computer scientists within the field of medicine.

Today's rich digital information environment is characterized by the multitude of data sources providing information that has not yet reached its full potential in eHealth. The aim of the presented approach, namely CrowdHEALTH, is to introduce a new paradigm of Holistic Health Records (HHRs) that include all health determinants. HHRs are transformed into HHRs clusters capturing the clinical, social and human context of population segments and as a result collective knowledge for different factors. The proposed approach also seamlessly integrates big data technologies across the complete data path, providing of Data as a Service (DaaS) to the health ecosystem stakeholders, as well as to policy makers towards a “health in all policies” approach. Cross-domain co-creation of policies is feasible through a rich toolkit, being provided on top of the DaaS, incorporating mechanisms for causal and risk analysis, and for the compilation of predictions.

Efforts are underway to understand recent increases in emergency department (ED) use and to offer case management to those patients identified as high utilizers. Homeless Veterans are thought to use EDs for non-emergent conditions. This study identifies the highest users of ED services in the Department of Veterans Affairs and provides descriptive analyses of these Veterans, the diagnoses for which they were seen in the ED, and differences based on their homeless status. Homeless Veterans were more likely than non-homeless Veterans to have >10 visits in the 2014 calendar year (12% vs. <1%). Homeless versus non-homeless Veterans with >10 visits were more often male, <age 60, and non-married. Non-homeless Veterans with >10 ED visits were often treated for chest and abdominal pain, and back problems, whereas homeless Veterans were frequently treated for mental health/substance use. Tailored case management approaches may be needed to better link homeless Veterans with high ED use to appropriate outpatient care.

Due to the various beneficiaries of Electronic Health Records (EHR), the information requirements of each group should be taken into account while designing the EHR. In line with the priority of implementing electronic health records in the province of Sistan and Baluchestanin Iran, this study aims to assess the dental information requirements of EHR at Zahedan Dental School. This cross-sectional study was performed in 2014. The study population comprised 6565 faculty members, residents of dental school and staff in Health Information Management of Zahedan Hospitals. The data collection instrument was a questionnaire which comprised six sets of data and 67 informative elements that were prioritized based on the average of scores. Data were analyzed by using descriptive statistics, SPSS. All the elements, except two ones including marital and employment status which were considered as the second priority with average scores below 7, other proposed elements such as clinical findings, final diagnosis, oral health status, drug sensitivity, main complaint, patient's full name, required X-rays, medical record number, and the discharge recommendations of an average above 7 were regarded as the first priority of the respondents. In conclusion, it is recommended that these findings should be considered in the design of electronic health records system at Zahedan Dental School.

Little is known about the clinical effects of shared medical decision making (SMDM) associated with quality of life about oral cancer? To understand patients who occurred potential cause of SMDM and extended to explore the interrelated components of quality of life for providing patients with potential adaptation of early assessment. All consenting patients completed the SMDM questionnaire and 36-Item Short Form (SF-36). Regression analyses were conducted to find predictors of quality of life among oral cancer patients. The proposed model predicted 57.4% of the variance in patients' SF-36 Mental Component scores. Patient mental component summary scores were associated with smoking habit (β=−0.3449, p=0.022), autonomy (β=−0.226, p=0.018) and Control preference (β=−0.388, p=0.007). The proposed model predicted 42.6% of the variance in patients' SF-36 Physical component scores. Patient physical component summary scores were associated with higher education (β=0.288, p=0.007), employment status (β=−0.225, p=0.033), involvement perceived (β=−0.606, p=0.011) and Risk communication (β=−0.558, p=0.019). Future research is necessary to determine whether oral cancer patients would benefit from early screening and intervention to address shared medical decision making.

Much has been written on the benefits of big data for healthcare such as improving patient outcomes, public health surveillance, and healthcare policy decisions. Over the past five years, Big Data, and the data sciences field in general, has been hyped as the “Holy Grail” for the healthcare industry promising a more efficient healthcare system with the promise of improved healthcare outcomes. However, more recently, healthcare researchers are exposing the potential and harmful effects Big Data can have on patient care associating it with increased medical costs, patient mortality, and misguided decision making by clinicians and healthcare policy makers. In this paper, we review the current Big Data trends with a specific focus on the inadvertent negative impacts that Big Data could have on healthcare, in general, and specifically, as it relates to patient and clinical care. Our study results show that although Big Data is built up to be as a the “Holy Grail” for healthcare, small data techniques using traditional statistical methods are, in many cases, more accurate and can lead to more improved healthcare outcomes than Big Data methods. In sum, Big Data for healthcare may cause more problems for the healthcare industry than solutions, and in short, when it comes to the use of data in healthcare, “size isn't everything.”

Often, clinical decision making of reconstructive procedure is coupled and their concurrent resolution by interacting stakeholders is required. This study was to give new insight into the tradeoff method to elicit the utility function first and then the probability weighting function, to determine if and how stakeholder engagement can contribute to managing decisional conflict processes. The proposed methodology is illustrated through three subjects (physician, patient and family member). We found that significant evidence of probability weighting both at the aggregate level and at the individual subject level. The pattern of probability weights is consistent with an inverse shaped probability weighting function: Small probabilities are overweighed and intermediate and large probabilities are underweight. In addition, the degree of upper subadditivity exceeds the degree of lower subadditivity. Finally, the proposed procedure can reduce clinical risk by considering stakeholders' behavior attribute and providing physicians the effective support need for quality decision making.

Health information systems can improve the quality of services in healthcare. Evaluation of health information systems in hospitals is a very complex process, and it is more effective when different aspects are considered. The present work aims to develop an evaluation framework of an integrated HIS in order to improve the quality of healthcare services provided in Cyprus. Qualitative and quantitative methods were used, that measured three aspects of the system: technology, human factor and organization. Preliminary results showed that while participants seem to agree with the potential benefits of the integrated HIS, safety of data within the HIS is seen as a problem. Qualitatively, the study pointed to 3 factors that might improve the current integrated HIS: increasing interdisciplinary cooperation, training of staff, and upgrading the infrastructure. Further studies will provide a comprehensive picture for Cyprus, so that appropriate measures can be proposed and put in action.

The electronic survey in conjunction with GIS in the current study aims at presenting the needs and health problems of the elderly in individual Open Elderly Care Centres in Greece. The online GIS survey enables the continuous monitoring and developing of the health problems of the elderly and helps them in their early care by the healthcare units. GIS survey123 is a customizable tool, which can be used to conduct research that is then published on an Android, iOS, and web platform. The ArcGIS software was used for the geographic mapping of data collected from a wide range of sources, so that health care professionals can investigate the factors associated with the onset of the diseases. Also, direct geographic mapping aims at identifying health problems of the elderly in Greece and transferring information to health care professionals in order to impose proper control measures in a very small period of time.

The purpose of this study is to investigate the knowledge and use of Information and Communication Technologies (ICT) from community-based patients, while the results were visualized on maps by using Geographic Information Systems (GIS). Of the 779 participants, 37.4% of the patients responded that they were aware of the availability of ICTs available for dementia, with only 9.2% responding that they were using individual devices. It was apparent that 94.7% of those with a university education had knowledge of ICT and 47.4% of them did use, unlike patients with lower levels of education. In conclusion, based on a small sample of the Greek population, the knowledge and use of ICTs is still on a limited scale and mainly concerns patients with high socioeconomic status.

The Artificial Pancreas is a medical device, currently in development, that aims to provide automatic regulation of blood glucose (BG) levels in ambulatory type 1 diabetes mellitus sufferers. The most popular approach utilises subcutaneous (SC) continuous glucose monitoring (CGM) combined with SC insulin injection controlled by a Model Predictive Control (MPC) algorithm. From a safety risk perspective problematic elements include the performance robustness of the CGM and the need for a pre-meal insulin bolus to provide satisfactory post prandial BG regulation. This contribution presents preliminary in silico studies which indicate that the use of an alternative approach to insulin delivery - intra-peritoneal (IP) infusion - could provide a similar level of BG regulation (as obtained with SC delivery), without the need for the pre-meal bolus. This simplified control architecture would remove the patient safety risk related to the administration (or not) of pre-meal bolus.

As patient numbers continue to rise Emergency Department's (ED's) are struggling to not only control patient wait times but also to maintain the quality of patient care. Improving patient flow through the ED has been a priority for many years with techniques such as Lean Six–Sigma being implemented specifically to help alleviate the problem. The Institute for Healthcare Improvement recently stated that the best opportunities to improving patient flow relate to the front-end of the ED, namely triage. This contribution examines the use of Telehealth initiatives at the front-end of the ED, specifically tele-consultation, to reduce patient loading, provide timelier healthcare (with improved patient outcomes) and reduce costs.

The main cause of non-traumatic subarachnoid haemorrhage is an intracranial aneurysm's rupture. The choice of treatment approach is exceptionally difficult in cases of aneurysms with additional branches on the aneurysm's dome or neck. The impact of the arterial branches on local hemodynamics is still unclear and controversial question. At the same time, up-to-date methods of image processing and mathematical modeling provide a way to investigate the hemodynamic environment of aneurysms. The paper discusses hemodynamic aspects of aneurysms harboring arterial branch through the use of patient-specific 3D models and computational fluid dynamics (CFD) methods. The analysis showed that the presence of the arterial branches has a great influence on flow streamlines and wall shear stress, particularly for side wall aneurysm.

Recent technological advances in electronics, wireless communications and low cost medical sensors generated a plethora of Wearable Medical Devices (WMDs), which are capable of generating considerably large amounts of new, unstructured real-time data. This contribution outlines how this data can be propagated to a healthcare system through the internet, using long distance Radio Access Networks (RANs) and proposes a novel communication system architecture employing White Space Devices (WSD) to provide seamless connectivity to its users. Initial findings indicate that the proposed communication system can facilitate broadband services over a large geographical area taking advantage of the freely available TV White Spaces (TVWS).

Mobile Electronic Data Collection Tools (MEDCTs) are created by form developers to collect data. Usability being one of the top quality attributes is of great concern to developers of any interactive applications. However, little is known about the form developers' understanding of usability, how they measure usability and their limitations in designing for usability. We conducted an empirical study where we aimed at getting the developers' views on usability by interviewing 8 form developers. These are creators of forms used for data collection. We found that developers knew about usability, but it was not their main focus during form development. Challenges included constraining deadlines, software limitations and the insufficient communication with the field users to establish the usability needs. Furthermore, the methods used to evaluate the usability of created forms varied amongst developers and these included in-house evaluations and feedback from piloting sessions with end users.

Protecting connected medical devices from evolving cyber related threats, requires a continuous lifecycle approach whereby cybersecurity is integrated within the product development lifecycle and both complements and re-enforces the safety risk management processes therein. This contribution reviews the guidance relating to medical device cybersecurity within the product development lifecycle.

From the mid-1990s, data mining methods have been used to explore and find patterns and relationships in healthcare data. During the 1990s and early 2000's, data mining was a topic of great interest to healthcare researchers, as data mining showed some promise in the use of its predictive techniques to help model the healthcare system and improve the delivery of healthcare services. However, it was soon discovered that mining healthcare data had many challenges relating to the veracity of healthcare data and limitations around predictive modelling leading to failures of data mining projects. As the Big Data movement has gained momentum over the past few years, there has been a reemergence of interest in the use of data mining techniques and methods to analyze healthcare generated Big Data. Much has been written on the positive impacts of data mining on healthcare practice relating to issues of best practice, fraud detection, chronic disease management, and general healthcare decision making. Little has been written about the limitations and challenges of data mining use in healthcare. In this review paper, we explore some of the limitations and challenges in the use of data mining techniques in healthcare. Our results show that the limitations of data mining in healthcare include reliability of medical data, data sharing between healthcare organizations, inappropriate modelling leading to inaccurate predictions. We conclude that there are many pitfalls in the use of data mining in healthcare and more work is needed to show evidence of its utility in facilitating healthcare decision-making for healthcare providers, managers, and policy makers and more evidence is needed on data mining's overall impact on healthcare services and patient care.

This paper presents a safety reporting smartphone application which is expected to reduce the occurrence of postoperative adverse events after total hip arthroplasty (THA). A user-centered design approach was utilized to facilitate optimal user experience. Two main implemented functionalities capture patient pain levels and well-being, the two dimensions of patient status that are intuitive and commonly checked. For these and other functionalities, mobile technology could enable timely safety reporting and collection of patient data out of a hospital setting. The HCI expert, and healthcare professionals from the Haukeland University Hospital in Bergen have assessed the design with respect to the interaction flow, information content, and self-reporting functionalities. They have found it to be practical, intuitive, sufficient and simple for users. Patient self-reporting could help recognizing safety issues and adverse events.

As Decision Support Systems start to play a significant role in decision making, especially in the field of public-health policy making, we present an initial attempt to formulate such a system in the concept of public health policy making for hearing loss related problems. Justification for the system's conceptual architecture and its key functionalities are presented. The introduction of the EVOTION DSS sets a key innovation and a basis for paradigm shift in policymaking, by incorporating relevant models, big data analytics and generic demographic data. Expected outcomes for this joint effort are discussed from a public-health point of view.

The “research apartment Halberstadtstraße” (HSS) in Braunschweig, Germany, is the attempt to realize a personal living environment as a room for diagnostics and therapy with the support of health-enabling and ambient assistive technologies (HEAAT). As a research tool, the HSS will enable the efficient implementation of new HEAAT and help in evaluating these under controlled real-life conditions. This new research tool will therefore be the missing link between artificial laboratory and complete real-life conditions. For a defined period, selected subjects can live in the HSS and experience the benefit of such a “Smart Home”. The academic support in a real-life controlled living-environment enables continuous monitoring of behavior patterns and habits of healthy and ill persons, evaluation of new HEAAT, and conduction of requirements analysis and acceptance studies.